Organization
BRETHREN HOME
Active
Other names
Pinecrest Manor
Organization subpart
No
Provider details
NPI number
Authorized official
FEROL J LABASH NHA (CHIEF EXECUTIVE OFFICER)
(815) 734-4103
Entity
Organization
Contact information
Practice address
414 S WESLEY AVE, MOUNT MORRIS, IL 61054-1428
(815) 734-4103
(815) 734-7318
Mailing address
414 S WESLEY AVE, MOUNT MORRIS, IL 61054-1428
(815) 734-4103
(815) 734-7318
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2038043
LICENSE NUMBER
IL
Enumeration date
03/20/2013
Last updated
04/05/2013
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